NYC Cat Coalition Adoption Application

ADOPTION APPLICATION
*To be considered, application must be completely filled out unless questions do not apply. (including any spousal/partner info on Pg1)
Name of Cat(s) Requested*
PERSONAL INFORMATION #1:
Name*
Age*
Address*

Street

Apt #

City/State/ZipState / Province

Postal / Zip Code
Phone #*

Home #Cell #
Email*
example@example.com
How long have you lived at this address?*
Employer information #1
Who is your Employer?*
What is your Occupation/Title? *
Phone # of Employer*
Contact*
Address*

Street

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
How long have you worked for this company?*

YearsMonths
PERSONAL INFORMATION #2 :

*Please fill out for spouse/partner*
Name
Age
Address

Street

Apt #

City/State/ZipState / Province

Postal / Zip Code
Phone #

Home #Cell #
Email
How long have you lived at this address?
(If less than 2yrs, please provide previous address)
Employer information #2
Who is your Employer?
What is your Occupation/Title?
Address

Street

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Phone # of Employer
Contact
How long have you worked for this company?

YearsMonths
Residence information
Previous or Secondary Residence
If you have lived at your current residence for less than 2 years, please include your previous address
Do you own or rent your current address?*

OwnRent
*The following questions apply only if you are renting your current residence*
When does your lease expire?

MonthYear
Does your lease permit pets?

YesNo
Name of landlord or Renting Agent
Phone # of landlord or Renting Agent
Are you adopting for yourself of someone else?*
Do you know cats can live 15-20 years?*

YesNo
Why are you adopting a cat at this point and time?*
Do you have a terrace?*

YesNo
Do you have screens on your windows?*

YesNo
Is your terrace enclosed?*

YesNoDon't have a terrace
If you have a terrace, does it have a screen door?*

YesNoDon't have a terrace
Do you have a backyard?*

YesNo
Is your backyard enclosed?*

YesNoDon't have a backyard
Where did you learn about us?*

PetfinderAdopt-A-Pet.comRescueMe.orgOther
Does your current job require extensive travel?*

YesNo
If you have been with your current employer for 2 years or less, please provide the name of your previous employer
Address of Previous Employer
Phone # of previous employer
What arrangements will you make for the care of your pet(s) while you are away on business or vacation?*
PERSONAL REFERENCE:
Name*
Phone #*
Relationship*
(Friend, Sibling, Parent, Child, Colleague )
Address*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
BACK UP ADOPTER

Who would take custody of your pet(s) IF for any reason you could no longer care for them?
Name*
Phone #*
Please enter a valid phone number.
Address*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
PERSONAL
Do you have others living in your home?*

YesNo
*If yes, please fill out the information below*
Household member #1
Name
Age
Relationship
(Child, Parent, Partner, Roomate)
Household member #2
Name
Age
Relationship
(Child, Parent, Partner, Roomate)
Household member #3
Name
Age
Relationship
(Child, Parent, Partner, Roomate)
Household member #4
Name
Age
Relationship
(Child, Parent, Partner, Roomate)
Does anyone in your family have allergies to animals?*

YesNo
If yes, how will you handle an animal entering your home?
ADOPTION HISTORY:
Have you had pets before?*

YesNo
If yes, please specify

Dog(s)Cat(s)Other
If other, please specify
(Hamster, bird, fish, etc)
*The following questions apply only if you currently have or have previously had pets*
How long did you have this pet?

YearsMonths
Where is the pet now?
If the pet was given away, why?
Who did you give the pet to?
Are there any other animals in your home now?*

YesNo
If yes, describe
(Cat, dog, hamster, etc)
How many dogs have you owned?
Please provide names, ages, and gender of dogs

Names/AgesGender
How many cats have you owned?
Please provide names, ages, and gender of cats

Names/AgesGender
Are your current pets spayed or neutered?*

YesNoNever had pets
Were your prior pets spayed/neutered?*

YesNoAllSomeNever had pets
Have you adopted from a Rescue Organization or Shelter in the past?*

YesNo
If yes, when did you adopt from the Rescue/Organization?
(Approximate year is acceptable)
Name of Organization
Phone#
Name of Pet adopted from organization
PREFERENCES:
Would you prefer a declawed cat?*

YesNo
Do you need a cat to catch mice?*

YesNo
Will you Declaw (permanently remove claws surgically) the cat or kitten you would like to adopt?*

Yes, Front Paws OnlyYes, Front and Back PawsNo
Pet will be kept:*

Indoors OnlyOutdoors OnlyIndoors and Outdoors
What type of food does/did your cat eat?*
What food will you give your new cat?*

Dry OnlyCanned OnlyBothOther
Do you want a cat that can travel well in a car?*

YesNo
Do you want a cat that will sleep in bed with you?*

YesNo
Describe what type of personality traits you want in a cat*
Do you currently have a Veterinarian? If yes, please provide your veterinarian's information below (this is required)*

YesNoPet never saw a Veterinarian
Name
(Name of Veterinarian or place)
Name of Pet
Phone#
Address

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
If you don't currently have a Veterinarian, who is the Veterinarian you’ve used in the past? (Required if you have owned pets previously)
Name
(Name of Veterinarian or place)
Name of Pet
Phone#
Address

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
I certify that all of the above information is true and accurate and I authorize the Representatives of NYC CAT COALITION to contact those listed above. I understand that if I adopt a cat/kitten from the NYC Cat Coalition and it is later discovered that I have falsified any information on this Application, the adoption will be null and voice and I must return the cat/kitten(s) to the NYC Cat Coalition.

In order to be considered as an adopter, you MUST: Be 21 Years of Age or Older

Provide identification showing your present address Have the knowledge and consent of your Landlord
Signature 1*

Clear
Date*

MonthDayYear
Date
Signature 2

Clear
Date

MonthDayYear
Date
Additional comments
Should be Empty:

ADOPTION APPLICATION

PERSONAL INFORMATION #1:

Employer information #1

PERSONAL INFORMATION #2 :

Employer information #2

Residence information

PERSONAL REFERENCE:

BACK UP ADOPTER

PERSONAL

Household member #1

Household member #2

Household member #3

Household member #4

ADOPTION HISTORY:

PREFERENCES: